Yulius Hermanto

Background: Tuberculous meningitis (TBM) is the most common central nervous system (CNS) infection caused by “ Mycobacterium tuberculosis ,” leading to significant neurological deficits and high mortality rates. Effective treatment is essential to control the infection. This literature review aims to evaluate recent advancements in anti-tuberculosis therapy for TBM, focusing on optimizing treatment regimens. Methods: This literature review primarily draws from studies available in the PubMed and Scopus databases on TBM regimens, focusing on publications that evaluate higher doses or novel drug therapies. Key search terms included “tuberculous meningitis,” “anti-tuberculosis therapy,” and “novel treatment regimens.” Results: Findings suggest that while standard tuberculosis (TB) regimens are effective for pulmonary TB, they may be suboptimal for TBM due to limited CNS drug penetration. Recent investigations propose higher drug doses and novel medications to enhance efficacy in TBM treatment. Conclusion: The review highlights the need for TBM-specific treatment regimens with optimized dosing and new drug formulations to improve patient outcomes. Further research is needed to validate these emerging therapies.

Background: Tuberculous meningitis (TBM) is the most common central nervous system infection of Mycobacterium tuberculosis (M.tb). The infection will cause focal neurological deficits and can be fatal, so that it will increase the morbidity and mortality rates. Adequate treatment is needed so that the drug can reach the center of infection. Not all anti-tuberculosis (TB) drugs can effectively cross the blood–brain and blood-cerebrospinal fluid barriers. The use of higher doses is expected to be able to work on the center of infection effectively. However, the use of higher doses will also increase the risk of drug-induced liver injury, which requires temporary discontinuation of the suspected drug. Methods: This scientific work aims to determine the penetration rate of first-line anti-TB drugs that are often used in patients infected with M.tb, especially TBM. Journal searches were performed on PubMed/PMC and BioMed Central/BMC search engines with the appropriate keywords. Critical appraisal analysis was carried out in selected journals. CSF sampling can be done to establish the diagnosis of TBM. CSF characteristics in TBM include lymphocyte pleocytosis, increased protein levels, and decreased glucose levels. Results: The results of CSF analysis depend on the volume of CSF used, the delivery of the sample, and the technical expertise of the clinician. If clinically, a patient is suspected of having TBM even though the results of CSF analysis show negative results for M.tb bacteria, a drug regimen can be given immediately to prevent worsening of the patient’s condition. Bacterial cultures may be performed as treatment progresses. Based on the penetration rate of anti-TB drugs in the CSF, isoniazid (INH), pyrazinamide, and fluoroquinolones, especially levofloxacin, are drugs with fairly good CSF penetration. Conclusion: The use of INH is beneficial because it has high bactericidal activity. Gatifloxacin and ciprofloxacin, which are included in the fluoroquinolone class of drugs, are safe to use even though their CSF penetration is not as good as levofloxacin.

Background: Tuberculum sellae meningiomas (TSMs) represent a distinct entity among intracranial meningiomas. Both transcranial approaches (TCAs) and endoscopic endonasal approaches (EEAs) have provided neurosurgeons with options for managing these difficult tumors. Still, controversies persist regarding the selection criteria for the most optimal approach. Methods: The authors retrospectively reviewed 45 patients treated surgically for TSM between 2018 and 2023. The clinical reports of all subjects were assessed pre-and post-operatively, encompassing demographic information, clinical symptoms, imaging results, ophthalmological evaluations, operative details, and any complications. Results: A total of 45 patients were included in this study, with 21 patients undergoing EEAs and 24 TCAs. TSMs treated with EEA are smaller than TCA (P = 0.0014), less prevalent in optic canal invasion (P = 0.0291) and in arterial encasement (P = 0.0050), and have no lateral extension (P < 0.0001). The majority of patients (36/45) had visual improvement or stabilization following the surgery, with the rate of achieving gross total resection (GTR) was higher in the EEA group (17/21) than in the TCA group (9/24) (P = 0.0032). The mortality tends to be higher in the TCA group and is related to arterial encasement, although statistically insignificant. Conclusion: Both traditional TCAs and EEAs offer options for the surgical management of TSM, each with its advantages and limitations. Based on our experiences, several factors (lateral extension and arterial encasement) may guide the suitable approach, and multidisciplinary considerations, with the overarching goals of achieving maximal tumor resection and minimizing postoperative complications.